Add Dental Coverage Subsidy to Reform Law: It's a Bargain!
The Affordable Care Act (ACA) doesn't do much to help people who don't have dental insurance. I find that strange for a couple of reasons: First, dental care is a form of healthcare, and the lack of it can seriously harm your health. Second, it would cost the government relatively little to subsidize dental coverage for those who are currently uninsured.
Estimates of how many people lack dental coverage vary from 108 million to 132 million. Whatever the correct figure is, it's more than twice the number who don't have medical insurance. Yet, while the reform law is expected to result in 32 million more people getting medical coverage, far fewer will obtain access to dental care. The ACA requires health plans to cover dental fillings for children; and starting in 2014, their parents will be able to buy dental coverage for their kids through the new state insurance exchanges. Eventually, more adults will receive dental coverage under Medicaid. But most state Medicaid programs pay so little that only a minority of dentists accept that insurance.
What's crazy about our approach to dental coverage is that it's really essential to good health. An untreated abscess, for instance, can lead to serious consequences, including sepsis and death. Periodontal disease has been linked to an increased risk of heart attacks, strokes, and respiratory illnesses. The loss of teeth makes it difficult to eat, and untreated cavities can cause great pain, both of which reduce productivity and quality of life. When people are forced to seek dental care without insurance, it can bankrupt them.
Seniors have to buy Medigap policies to cover dental care, because it's not part of Medicare. Only some employers offer dental coverage, and people who are self-employed can't obtain effective dental insurance. The individual policies that are available where I live, for example, are designed so that the premiums cost nearly as much as the maximum payout.
So why didn't Congress tackle this problem head-on? One reason was the cost of covering more than 100 million people. But that cost might be much lower than the lawmakers supposed.
To provide a rough idea of what it might cost to reach near-universal dental coverage, here are a few numbers: In 2008, the entire country spent $101 billion on dental care. If we assume a degree of equivalence between the costs of insurance and of care, it would have cost around $35 billion more to cover the third of the population that was uninsured. But if the government required people to buy dental insurance and subsidized those with lower incomes, the federal cost would be far less than that. For argument's sake, let's say the government had to lay out $20 billion a year. From that amount we could subtract, say, $5 billion for savings in medical costs from addressing dental problems that otherwise would have gone untreated. Much of that would be recaptured by the Medicare and Medicaid programs.
Of course, the remaining $15 billion would rise each year: in fact, national dental costs jumped 63 percent from 2000 to 2008. So, in return for providing subsidies to expand dental coverage, dentists would have to join managed-care dental plans in the insurance exchanges to get the government-subsidized business. Such plans would use a combination of negotiated rates and value-based purchasing to keep dental cost growth to a dull roar.
Persuading Congress to pay for increased dental coverage would not be easy. In an environment where the White House had to pull teeth (metaphorically) to get unemployment benefits extended, any proposal that adds to the deficit is going to face rough going. But, considering that a third of the population has little or no access to dental care, it shouldn't be too hard for most Congressional Democrats to finish the job of healthcare reform.
Image supplied courtesy of NASA.
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